Provider Demographics
NPI:1386267938
Name:BROWN, PARKER
Entity type:Individual
Prefix:
First Name:PARKER
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:PARKER
Other - Middle Name:NIELSON
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:JORDAN VALLEY DENTAL
Mailing Address - Street 2:7452 S CAMPUS DRIVE
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84084
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:JORDAN VALLEY DENTAL
Practice Address - Street 2:7452 S CAMPUS DRIVE
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84084
Practice Address - Country:US
Practice Address - Phone:801-282-2323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-18
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11732637-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice